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    Understanding Breakthrough Pain and Flares

    Why, When, How Often, and How Long continued...

    “Another problem is called end-of-dose failure,” Shaparin tells WebMD. “This happens when a patient is started on a long-acting opioid. Although the medication is supposed to last 12 hours, in some people it lasts less; at times, only eight hours. The person experiences BTP when the long-acting drug is not effective for the intended length of time.”

    Whatever the cause, breakthrough pain comes on suddenly, often without warning, and it can happen even if a person is taking medication for chronic pain. It reaches peak intensity within three minutes and normally lasts 30 to 60 minutes.

    People with chronic pain who take opioid drugs experience breakthrough pain or severe flares an average of twice a day, or 14 times each week, according to an American Pain Foundation report.

    Another study showed that the average noncancer patient had BTP over a period of three-and-a-half years. According to the National Pain Foundation, researchers estimate that more than 80% of people taking long-acting medications for chronic pain experience breakthrough pain.

    Drugs Designed for Breakthrough Pain

    For a drug to be effective in treating breakthrough pain, it should be:

    • Fast-acting.
    • Flexible enough to get you through the flare, but not much longer.
    • Easy to take.

    Short-acting and ultra short-acting drugs to relieve breakthrough pain are available in a variety of forms:

    • Tablets taken by mouth.
    • A lozenge on a handle. This medication dissolves through mucus membranes in the mouth to provide rapid pain relief.
    • A film that dissolves when placed on the inside of the cheek.
    • Injection.
    • Sublingual (under the tongue).
    • Nasal spray.

    Over-the-Counter Pain Relief Options

    Ibuprofen and naproxen sodium, known as nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen are over-the-counter medications used to treat mild breakthrough pain. Some might argue that breakthrough pain is never mild, but OTC medications shouldn’t be totally dismissed. They might work for some people. Doctors occasionally recommend their use in combination with prescription pain drugs to:

    • Provide a synergistic (combination) effect.
    • Stagger the timing of pain relief drugs.
    • Reduce the amount of narcotics being taken during a relatively short time period.

    Side effects of NSAIDs may include upset stomach, nausea, vomiting, heartburn, headache, diarrhea, and/or constipation.

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